MEDICATION MANUAL Policy & Procedure

Transcription

1 MEDICATION MANUAL Policy & Procedure TITLE: Section: Initial Management of Anaphylaxis Following Immunization Medication Specific NUMBER: MM Date Issued: October 2009 Source: Distribution: Capital Health Nurse Pharmacy Committee Holders of Medication Manual Date To Be Reviewed: Issuing Authority: October 2012 Director Professional Practice THIS IS A POST- ENTRY LEVEL COMPETENCY FOR REGISTERED NURSES AND LISENCED PRACTICAL NURSES (IN SPECIFICALLY APPROVED PRACTICE SETTINGS) AND REQUIRES ASSESSMENT OF COMPETENCY PRIOR TO PERFORMING PREAMBLE Anaphylaxis is a life threatening reaction to a foreign substance that requires immediate treatment. It is important to be prepared to respond to anaphylaxis prior to administration of any product. The recommended first line of treatment of anaphylaxis is the timely administration of epinephrine and diphenhydramine (Benadryl ). POLICY 1. Management of anaphylaxis following immunization (see definition) is a post-entry level competency for RNs and LPNs which requires assessment of competency, by successful completion of the Immunization Learning Module Additionally, LPNs working in specifically approved practice settings require successful completion of an approved Post- Entry Level Competency program in immunization (e.g.: NSCC Immunization Program of LPNs) 2. An authorized prescriber s order or pre-printed order is required for all programs and services administering medications required in the management of anaphylaxis following immunization. Exception: Public Health Services; acting under the direction of the Medical Officer of Health. Initial Management of MM Page 1 of 5

3 PROCEDURE 1. In the event of anaphylaxis, activate the emergency response as applicable to your practice area (Call 911 for EHS services or 3333 for Code Blue response) Position the patient in the recumbent position with legs elevated Provide the ABCs of resuscitation (Airway,( Breathing, Circulation ). 2. As per the authorized prescriber s order, immediately administer aqueous epinephrine intramuscularly (IM), 1:1000 in appropriate dose according to age/body weight. (Dosage: 0.01ml/kg to a maximum of 0.50 ml) 2.1. Administer epinephrine IM preferentially into an anterolateral, unimmunized thigh site (vastus lateralis). Note: This is applicable for all ages. The injection can be made through clothing If administration into a thigh is problematic, epinephrine may be administered IM into the deltoid muscle of children greater than or equal to 12 months of age and to adults When both thighs have been used as immunization sites, administer epinephrine into a site in the thigh that is at least 2.5 cm (1 inch) away from any immunization site As this may not be possible in some young infants with small thigh muscle mass, separate the sites with as much distance as possible DO NOT inject epinephrine directly into an IM immunization site as it dilates blood vessels and speeds absorption of the vaccine (i.e. the offending allergen). Table 1: Appropriate Dose of Epinephrine (1:1000) AGE Weight (kg)* In kg Weight (lbs)* In lbs Dosage 1 mg/ml (1:1000) 0.01 ml/kg 2 to 6 months 4-7 kg 9-15 lbs 0.07 mg (0.07 ml) 7 to 18 months 7-11 kg lbs 0.10 mg (0.10 ml) 19 to 48 months kg lbs 0.15 mg (0.15 ml) 49 months to 5 years kg lbs 0.20 mg (0.20 ml) 6-9 years kg lbs 0.30 mg (0.30 ml) years kg lbs 0.40 mg (0.40 ml) Greater than or equal to 14 years 45+ kg 99+ lbs 0.50 mg (0.50 ml) * Dosing by body weight is preferred Source: CIG (2006), p. 83., Red Book (2006) 3. Assess need to administer ONE dose diphenhydramine (Benadryl ). (Dosage: 1-2 mg/kg to a maximum single dose of 50 mg. See Table 2.) Note: Oral Treatment is preferred for conscious patients (appropriate dose according to age) in non-hospital settings Administer IM injection in the unimmunized site as a separate injection (thigh or deltoid) Initial Management of MM Page 3 of 5

4 Table 2: Approximate Dose by Age of Diphenhydramine (Benadryl ) AGE Oral Route IM (50 MG/ML) (1-2 mg/kg) Less than 2 years 12.5 mg 12.5mg (0.25 ml) 2-4 years 25 mg 25 mg (0.50 ml) 5-11 years mg mg ( ml) Greater than or equal to 12 years 50 mg 50 mg (1.00 ml) Source: CIG (2006), p Repeat epinephrine at 5 minute intervals as needed (i.e. if breathing becomes more laboured or level of consciousness decreases) to a maximum of three doses. Alternate right and left thigh or arm sites for repeat doses of epinephrine (to maximize absorption of epinephrine). 5. Transport to acute care/emergency services, as needed (dependent on the setting in which the immunization/anaphylaxis occurred). 6. Documentation and Reporting 6.1. Complete documentation in the health record using Management of Anaphylaxis Initial Management Following Immunization form (CD2018MR) Report to the Manager and/or Attending Physician/Ordering Physician 6.3. Complete the Capital Health Patient Safety Report (on-line occurrence report) 6.4. Complete the Adverse Event Following Immunization (AEFI) (previously known as the Vaccine Associated Adverse Event form) and send to the Medical Officer of Health at Public Health Services through inter-office mail or fax to Note: Form can be found in the back of the CPS or at the Public Health Agency of Canada link: RELATED CAPITAL HEALTH DOCUMENTS Policies Immunization Administration and Learning Module (MM ) Forms Management of Anaphylaxis Initial Management Following Immunization form (CD2018MR) Initial Management of MM Page 4 of 5

1 of 6 1. OUTCOME To identify anaphylaxis in the primary care setting and provide an evidence informed emergency response utilizing the most current provincial and federal practice guidelines. 2. DEFINITIONS

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